Healthcare Provider Details

I. General information

NPI: 1679250633
Provider Name (Legal Business Name): TASFIA ANJUM KHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 BEACH AVE
ROCHESTER NY
14612-2011
US

IV. Provider business mailing address

10469 NW 289TH AVE
NORTH PLAINS OR
97133-2044
US

V. Phone/Fax

Practice location:
  • Phone: 917-686-6162
  • Fax:
Mailing address:
  • Phone: 469-386-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP25-01366
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP122560
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: